康复治疗对脑卒中患者的影响探讨

目的探讨康复治疗对脑卒中患者预后的影响,为进一步做好急性脑血管病患者临床预后提供科学依据。方法对兖州市人民医院2011年1月一2012年4月收治脑卒中患者104例做为研究对象,其中48例接受康复治疗（康复组）,另56例（常规组）接受传统常规治疗。结果康复组预后NIHSS评分比常规组下降趋势更为明显。康复组在治疗前与治疗后各阶段的NIHSS评分均有统计学差异（P〈0．01）;康复组和常规组在临床预后90dBarthel指数差别也有明显的统计学意义（P〈0．05）。康复组显效率（91．67％）优于常规组（73．21％）,差异有统计学意义（P〈0．05）。结论康复治疗对脑卒中患者术后生活质量的影响很大,能够使病人改善神经功能,恢复生活能力,提高生活质量。     

The effect of chronic azithromycin therapy on soluble endothelium-derived adhesion molecules in patients with coronary artery disease

In patients with coronary artery disease (CAD), azithromycin therapy is associated with decreased cytokine levels and overall reduction of inflammation. Chlamydia pneumoniae (C.Pn) is a common pathogen that may be an important factor in the development and progression of atherosclerosis. Cell-adhesion molecules have an important role in recruitment of inflammatory cells during plaque development and are expressed by endothelial cells on activation. We sought to define the effect of treatment with azithromycin on circulating levels of soluble vascular cell-adhesion molecule (VCAM-I), intercellular adhesion molecule (ICAM-1), and E-selectin in patients with CAD. Plasma concentrations of VCAM-1, ICAM-1, and E-selectin were measured in 40 patients with documented CAD and a positive (> or = 1:16) immunoglobulin G (IgG) titer against C.Pn, 20 subjects with normal coronary arteries, and 14 healthy volunteers. Patients were assigned randomly to receive either 500 mg/wk of azithromycin or placebo for 3 months. Serum samples were obtained at baseline, at 3 months, and during the follow-up visit at 6 months. Patients with documented CAD exhibited elevation of VCAM-1 (535 +/- 227 ng/ ml; p = 0.0001) and E-selectin (69 +/- 29 ng/ml; p = 0.006), but not ICAM-1 (321 +/- 65 ng/ml) concentrations as compared with the patients with angiographically proven normal coronary arteries (252 +/- 80; 50 +/- 22; and 311 +/- 40 ng/ml) and healthy controls (110 +/- 18; 29 +/- 2; and 238 +/- 47 ng/ml, respectively). Prolonged treatment with azithromycin did not significantly affect the plasma levels of soluble VCAM-1, ICAM-1, and E-selectin. Soluble markers of endothelial activation are markedly increased in patients with documented CAD as compared with those with normal coronary arteries and healthy controls. Despite substantial heterogeneity in plasma E-selectin, ICAM-1, and VCAM-1 levels, long-term azithromycin treatment did not affect plasma levels of these adhesion molecules, indicative of endothelial activation, over a period of 6 months.     

氟伐他汀联合非诺贝特治疗混合性高脂血症的可行性探讨

目的观察氟伐他汀联合非诺贝特治疗混合性高脂血症的临床效果。方法选择2007年1月至2008年12月南通市老年康复医院心内科门诊混合性高脂血症患者180例,随机分为氟伐他汀组、非诺贝特组、联合用药组各60例;氟伐他汀组每晚口服40mg氟伐他汀、非诺贝特组每晚口服非诺贝特200mg、联合用药每日清晨口服非诺贝特200mg,晚口服氟伐他汀20mg,均用至12周。观察血脂参数变化、疗效评价、药物主要不良反应。结果三组TC、LDL-C、TG治疗前无差异(P>0.05),氟伐他汀组治疗后TC、LDL-C均有显著性下降(P<0.05),TG变化不明显(P>0.05);非诺贝特组治疗后TG有显著性下降(P<0.05),TC、LDL-C变化不明显(P>0.05);联合用药组TC、LDL-C、TG均有显著性下降(P<0.05)。联合用药组临床控制(显效、好转)83.3%(50/60)高于氟伐他汀组的68.3%(41/60)和非诺贝特组的65.0%。三组患者血清CK、肝肾功能等参数均无明显变化,未出现肌病症状,无1例退出或终止。结论氟伐他汀联合非诺贝特对混合性高脂血症具有良好的安全性与耐受性,具有临床应用可行性。     

慢性阻塞性肺疾病患者血清细胞间黏附分子-1和可溶性E-选择素的检测及意义

目的 探讨慢性阻塞性肺疾病(COFD)患者血清细胞间黏附分子-1(ICAM-1)和可溶性E-选择素(E-selectin)的检测及意义.方法 采用酶联免疫吸附双抗体夹心(ELISA)法,检测60例COPD患者、52例急性加重期患者、52例缓解期患者和30例健康对照者血清ICAM-1和E-selectin水平.结果 COPD组、急性加重期患者血清ICAM-1和E-selectin水平明显高于对照组(P＜0.01);缓解期患者血清ICAM-1和E-electin水平明显低于急性加重期(P＜0.01);缓解期ICAM-1和E-electin水平高于对照组(P＜0.05).结论 ICAM-1、E-selectin参与了COPD的发生、发展.     

Drug therapy in patients with recent stroke

At present the treatment of the acute stroke is limited to managing the consequences of the primary event and attempting secondary prevention. The routine use of agents to reverse the cause or ameliorate the effects of stroke appears to be very controversial, and the value of secondary preventative measures is still far from clear. A large number of therapeutic trials have been performed in the past with no clear advantage for any drug. However, more recent studies are helping to clarify some aspects of treatment and may suggest that the active treatment of stroke is drawing near. This chapter discusses the treatments that have been tried in acute stroke, the reasoning behind their use and their performance so far. It also looks at newer treatments which may be important in the future.     

白介素-17和细胞粘附分子-1与慢性阻塞性肺疾病相关性的研究

目的探讨白介素-17（IL-17）和细胞粘附分子-1（ICAM-1）在慢性阻塞性肺疾病（COPD）发病中的作用及二者的相互关系。方法观察对象为COPD急性加重期住院患者（无其它炎症性疾病以及重要器官功能衰竭）40例,其中吸烟者20例,非吸烟者20例,缓解期患者40例,同期健康体检对象40人,无吸烟史。采用酶联免疫吸附法（E LI SA）对各组COPD患者的血清IL-17和ICAM-1含量进行测定,并同步测定外周血中性粒细胞计数及动脉血氧分压。结果 （1）COPD急性加重期组和缓解期组血清IL-17水平均高于健康对照组,且急性加重期组血清IL-17水平高于缓解期组（P均〈0.05）。（2）COPD急性加重期和缓解期组血清ICAM-1水平均高于健康对照组,且急性加重期组血清ICAM-1水平高于缓解期组（P均〈0.05）。（3）急性加重期吸烟组患者血清IL-17、ICAM-l水平高于非吸烟组（P〈0.05）。（4）COPD急性加重期组和缓解期组血清IL-17与ICAM-l水平均呈正相关（r值分别为0.518、0.507,P均〈0.05）,且在急性加重期这两个因子与外周血中性粒细胞计数均呈正相关（r值分别为0.634,0.367,P均〈0.05）,与PaO2呈负相关（r值分别为-0.676,-0.366,P均〈0.05）。结论 （1）IL-17和ICAM-1可能参与了COPD发病过程且与疾病分期及缺氧严重程度相关。（2）IL-17可能促进ICAM-1的表达,二者均与COPD全身炎症相关。（3）吸烟是促进COPD患者IL-17和ICAM-1表达的重要因素。     

尖锐湿疣患者血清lCAM-1的检测及其意义

目的探讨细胞间粘附分子-1(ICAM-1)在尖锐湿疣患者血清中的水平及其临床意义.方法用ELISA法检测15例尖锐湿疣患者血清中细胞间粘附分子-1水平.结果15例尖锐湿疣患者血清中,ICAM-1水平明显高于对照组.复发者,病变范围大者,其增高更为显著.结论尖锐湿疣的发生、发展与ICAM-1增高有关,检测ICAM-1血清水平有助于尖锐湿疣预后的判断.     

速避凝对缺血性脑卒中患者外周血可溶性粘附分子的影响

目的：通过比较速避凝治疗急性缺血性脑卒中患者过程中血浆可溶性粘附分子－1水平的变化,了解其对脑缺血性卒中患者外周血可溶性粘附分子－1的作用。方法：将36例24小时内发病的急性缺血性脑卒中患者随机分为速避凝组与丹参组,两组各18例,用ELISA方法测定治疗前与治疗后第3天和第7天的血浆可溶性粘附分子－1水平。结果：速避凝组治疗后第3天的血浆可溶性粘附分子－1水平与治疗前相比显著降低（P＜0．05）,丹参组治疗后第3天的血浆可溶性粘附分子－1水平与治疗前相比,则无明显差异（P＞0．05）。速避凝组治疗后第7天的可溶性粘附分子－1水平与治疗前相比,有极明显下降（P＜0．01）,丹参组治疗后第7天的可溶性粘附分子－1水平与治疗前相比,有显著差异（P＜0．05）。结论：速避凝在治疗缺血性脑卒中的过程中对降低患者外周血可溶性粘附分子－1的效果较丹参组更为显著。     

注射用丹参多酚酸对缺血性脑卒中患者ICAM-1、胆红素及早期神经功能的影响

目的 观察注射用丹参多酚酸对急性缺血性脑卒中患者细胞间黏附因子-1（ICAM-1）、胆红素及早期神经功能的影响,探讨注射用丹参多酚酸可能的作用机制。方法 回顾性以2020年1月—2020年10月在保定市第一中心医院神经内科住院的急性缺血性脑卒中患者100例为研究对象,根据治疗措施不同分为对照组和试验组,每组各50例。对照组为常规抗栓治疗,试验组在对照组基础上加用注射用丹参多酚酸,每次取0.13 g加入0.9%氯化钠注射液250 mL中稀释,静脉滴注,每天1次。两组均连续治疗14 d。在入院第1天、第14天分别收集患者血清,测定ICAM-1、胆红素水平,并应用美国国立卫生研究院卒中量表（NIHSS）评估患者的神经功能,评定两组治疗疗效,并观察治疗期间不良反应发生情况。结果 两组治疗前ICAM-1、胆红素水平及NIHSS评分比较,差异无统计学意义（P＞0.05）。两组治疗后NIHSS评分均较本组治疗前显著降低（P＜0.05）,且试验组NIHSS评分明显低于对照组（P＜0.05）。治疗后,对照组胆红素水平较本组治疗前显著降低（P＜0.05）,但试验组胆红素水平较本组治疗前显著升高,且高于对照组治疗后水平（P＜0.05）;两组ICAM-1水平均较本组治疗前显著降低（P＜0.05）,且试验组ICAM-1水平下降程度较对照组显著（P＜0.05）。试验组的治疗总有效率高于对照组（P＜0.05）。结论 注射用丹参多酚酸可能通过降低ICAM-1水平,升高胆红素水平发挥神经保护作用,改善缺血性脑卒中患者神经功能。     

Effects of atorvastatin,simvastatin, and fenofibrate therapy on monocyte chemoattractant protein-1 secretion in patients with hyperlipidemia

OBJECTIVE: Monocytes that migrate into the arterial wall participate in the development and, eventually, rupture of the atherosclerotic plaque. The aim of this study was to evaluate the secretion of monocyte chemoattractant protein-1 (MCP-1) by monocytes from hyperlipidemic patients treated with hypolipidemic drugs, namely fenofibrate, simvastatin, or atorvastatin to determine what role is played by these drugs in the development and stabilization of the atherosclerotic plaque. METHODS: Fifty-four hyperlipidemic patients, who did not respond to a low-fat diet, were treated with fenofibrate, simvastatin, or atorvastatin (18 patients in each group) for 1 month. The control group included 18 normolipidemic, healthy, age-matched participants. Ten hyperlipidemic patients were effectively treated with hypolipidemic diet alone for 1 month. This group was compared with a control group of ten healthy subjects. To accurately evaluate the adhesion molecule levels, we excluded hyperlipidemic patients and control subjects with any inflammatory disease. Before and after treatment, monocytes were isolated from peripheral blood. After stimulation with lipopolysaccharide (LPS), MCP-1 secretion was measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: MCP-1 levels were significantly higher in hyperlipidemic patients than controls: 15.8+/-0.47, 16.7+/-0.23, and 14.9+/-0.45 compared with 12.36+/-0.42 ng/ml. Fenofibrate, atorvastatin, and simvastatin significantly decreased MCP-1 levels from 15.8+/-0.47 to 8.79+/-0.89, from 16.7+/-0.23 to 7.46+/-0.73, and from 14.9+/-0.45 to 10.3+/-0.8 ng/ml, respectively. In the diet-treated group of hyperlipidemic patients, the level of MCP-1 before therapy was significantly higher than in controls (16.89+/-0.31 vs 12.45+/-0.36 ng/ml). The diet therapy caused a significant decrease in levels of MCP-1 to 15.1+/-0.36 ng/ml. There was a correlation between the decreased levels of lipids and the decreased release of MCP-1 in the patients treated with hypolipemic drugs. CONCLUSION: The drug-induced decrease in MCP-1 secretion in hyperlipidemic patients suggests that, apart from acting on lipids, the hypolipidemic drugs studied may directly inhibit the activity of monocytes.     

辛伐他汀对高脂血症患者单核细胞趋化蛋白-1和血管内皮功能的影响

目的：探讨辛伐他汀对高脂血症患者炎症因子单核细胞趋化蛋白-1（MCP-1）和血管内皮功能的影响。方法：选取高脂血症患者60例,采用双盲对照试验,把入选患者随机分为治疗组（n=30）和对照组（n=30）,并以健康志愿者作为正常对照组（n=26）。对照组患者仅给予低脂饮食,治疗组在推荐低脂饮食基础上给予辛伐他汀20 mg/d,疗程8周。采用超声心动图仪检测血管内皮依赖性血流介导的舒张功能（FMD）,采用酶联免疫吸附法（ELISA）检测MCP-1血清浓度。结果：高脂血症患者治疗前FMD显著低于正常对照组,MCP-1显著高于正常对照组。直线相关分析显示,MCP-1与FMD呈显著负相关（r=-0.562 0,P〈0.001）。经8周辛伐他汀治疗后,治疗组患者的TC、LDL-C和MCP-1显著降低（P〈0.05）,FMD较治疗前显著增高。FMD的增高程度与TC、LDL-C降低程度无显著相关性（r=-0.110 0,0.022 0,P〉0.05）。结论：辛伐他汀抗动脉粥样硬化作用可能部分与减少炎症因子MCP-1及改善血管内皮功能有关。辛伐他汀对高脂血症患者血管内皮依赖性舒张功能的改善可能部分独立于降脂作用。     

脂必泰与阿托伐他汀对高脂血症患者C反应蛋白的影响

目的探讨脂必泰和阿托伐他汀对C反应蛋白（CRP）的影响。方法76例高脂血症患者随机分为脂必泰组37例（口服脂必泰0．24g，每日2次，4周）和阿托伐他汀组39例（口服阿托伐他汀10mg，每晚1次。4周），治疗前后分别测定血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和高敏CRP（hsCRP）。结果4周后，两组hsCRP[分别为（3．2±0．6）mg／L、（3．1±0．7）mg／L]较治疗前[（4．4±0．5）mg／L、（4．5±0．4）mg／L]显著下降（P〈0.01）；TC、TG、LDL-C均较治疗前显著下降（P〈0．01）；两组治疗后HDL-C均无显著变化（P〉0．05）。结论脂必泰和阿托伐他汀不仅能调节血脂代谢，还可降低血清hsCRP浓度。     

Effect of rosuvastatin treatment on plasma visfatin levels in patients with primary hyperlipidemia

Visfatin is a novel adipokine involved in the process of atherosclerosis. We assessed the effect of rosuvastatin on plasma visfatin levels in patients with primary hyperlipidemia. Eighty hyperlipidemic patients without evidence of cardiovascular disease were randomized to receive either rosuvastatin 10 mg/day or therapeutic lifestyle changes intervention. Plasma visfatin levels were determined at baseline and after 12-weeks post-randomization. Rosuvastatin induced a significant decrease in plasma visfatin levels (17.1+/-2.1 versus 15.5+/-2.0 ng/ml, P=0.03). This effect correlated with baseline visfatin levels (r=0.51, P<0.01) and was independent of any lipid-lowering actions of rosuvastatin.     

综合护理干预联合运动疗法对脑卒中患者生活质量的疗效分析

目的探讨综合护理干预联合运动疗法对脑卒中患者生活质量的疗效。方法随机抽选我院2015年1月~2017年1月收治的60例脑卒中患者作为此次研究对象,按照入院先后顺序将其分为对照组与研究组各30例,两组均给予常规治疗与护理,研究组在此基础上实施综合护理干预联合运动疗法,对比两组患者干预前后生活质量评分变化。结果干预后,研究组康复治疗依从性明显优于对照组,差异有统计学意义(P<0.05);干预前两组患者运动功能分级例数比较差异无统计学意义(P>0.05),干预后研究组,两组肢体运动功能较干预前明显好转,组间比较研究组肢体运动功能≥Ⅳ级者明显高于对照组,差异有统计学意义(P<0.05);干预前两组SF-36各维度评分比较差异均无统计学意义(P>0.05);干预后两组SF-36各维度较干预前均有提高(除BP得分减少之外),组间评分提高程度比较,研究组显著高于对照组,差异有统计学意义(P<0.05)。结论实施综合护理干预联合运动疗法可显著提高脑卒中患者康复锻炼依从性,主动配合治疗护理工作,进而改善其肢体运动功能,对提高其生活质量具有重要意义,值得在临床推广应用。     

苯扎贝特治疗肾病综合症高脂血症疗效观察

目的观察苯扎贝特治疗肾病综合症,高血脂症的疗效.方法 60例患者随机分为两组,30例行常规治疗,30例在常规治疗的基础上加用苯扎贝特0.2g每日三次,疗程8周,服药前及服药后测定血脂.结果治疗组服药后总胆固醇(TC),三酰甘油(TG),低密度-脂蛋白(LDL-C)降低的有效率分别为83.33%,90.00%,85.00%,提高高密度脂蛋白-胆固醇(HDL-C)的有效率为80.95%,尿蛋白降低有显著性.结论苯扎贝特能有效改善肾病综合症的各项血脂指标,减少尿蛋白,升高血浆白蛋白,提高肾病综合症的缓解率,使用安全.     

强制运动疗法对脑卒中偏瘫患者上肢功能恢复的影响

目的探讨强制运动疗法对脑卒中偏瘫患者上肢功能恢复的影响。方法将42例脑卒中偏瘫患者分为强制运动治疗组（22例）和对照组（20例）。两组患者均给予作业疗法治疗。强制运动治疗组同时采用强制运动疗法训练。治疗前、后采用Fugl-Meyer量表评定患者的上肢综合运动功能,并进行日常生活活动（ADL）能力评定及简易上肢功能检查（STEF）评定。结果治疗后,两组患者的Fugl-Meyer量表评分、ADL及简易上肢功能检查（STEF）均较治疗前改善（P〈0.05）,且强制运动治疗组的疗效优于对照组（P〈0.05）。结论采用强制运动疗法结合作业疗法治疗,有利于提高脑卒中偏瘫患者上肢能力。     

替米沙坦对早期糖尿病肾病患者细胞间黏附分子-1和血管间黏附分子-1水平的影响

目的 观察替米沙坦对早期糖尿病肾病(DN)患者可溶性细胞间黏附分子-1(sICAM-1)和可溶性血管间黏附分子-1(sVCAM-1)水平的影响.方法 78例早期DN患者随机分为治疗组(n=40)和对照组(n=38),治疗组在接受原糖尿病治疗方案的基础上加用替米沙坦一日1次80 mg,为期5周,测定两组患者的sICAM-1和sVCAM-1水平.结果 治疗组血清sICAM-1和sVCAM-1水平较治疗前显著降低,且差异有统计学意义(P<0.05).结论 早期DN患者接受替米沙坦治疗后sICAM-1和sVCAM-1表达降低,提示上述因子可能与替米沙坦的肾功能保护作用有关,值得进一步研究验证.     

慢性乙型肝炎患者干扰素治疗前后血清可溶性细胞间粘附分子-1水平变化

目的　观察干扰素 - α1b(IFN- α1b)治疗慢性乙型肝炎患者前后血清可溶性细胞间粘附分子 - 1(s ICAM- 1)水平变化。方法　对慢性乙型肝炎治疗前行肝穿活检术 ,治疗前和治疗 6个月后 ,采用酶联免疫吸附方法 ,检测血清可溶性细胞间粘附分子 - 1的水平 ,观察干扰素对慢性乙型肝炎患者的疗效、干扰素疗效与肝组织炎症活动度的关系。结果　 IFN-α1b治疗后呈完全应答者4 5 .6 %、部分应答者 2 6 .1%、无应答者 2 8.3% ;肝组织炎症活动度为 G3者 ,干扰素治疗慢性乙型肝炎的疗效为 72 .2 %、G4者为75 .0 % ;完全应答者与部分应答者 ,治疗前后血清 s ICAM- 1水平的变化有显著性差异 (P<0 .0 1)。结论　 IFN- α1b可调控肝细胞表达 ICAM- 1,动态监测血清中 s ICAM- 1水平的变化 ,对评判干扰素抗乙肝病毒的疗效有一定的临床意义。     

肺结核患者血中可溶性细胞间粘附分子-1水平测定的临床意义

目的 探讨可溶性细胞间粘附分子-1(sICAM-1)在肺结核免疫机制中的作用和临床意义。方法 采用酶联免疫吸附(ELISA)法测定40例未经治疗及20例治疗2个月后肺结核患者的血清sICAM-1水平,并与20例正常健康人进行对照。结果 肺结核组血清sICAM-1水平明显高于健康对照组(P<0.05),其中血行播散型肺结核(Ⅱ型)组的sICAM-1水平高于继发型肺结核(Ⅲ型)组(P<0.05)。抗结核治疗后,血清sICAM-1水平明显下降,与治疗前相比差异有显著性(P<0.05),治疗2个月后肺结核患者sICAM-1水平仍高于对照组(P<0.05)。结论 sICAM-1产生增多,可能抑制了机体的抗结核免疫,是导致肺结核病发生发展的因素之一;且sICAM-1水平越高,病情越重,治疗后随sICAM-1水平降低,病情好转。sICAM-1参与了机体的免疫机制,可作为判断肺结核严重程度及疗效判定的一个临床指标。